Sharing Current Scottish Practice

Poster Abstracts of the Month: February

The SPPC Annual Conference in 2018 featured 48 poster displays, sharing work and research underway across Scotland. Each month, this blog focuses on the content of a few of these posters. This month, we focus on six of these:

01. A Critical Investigation of the Outcomes of
Specialist Palliative Day Services on Specific Components of Attendee Quality
Of Life: A Mixed Methods Study

Author(s)

Belinda Dewar; Jean Rankin; Elaine Stevens

This was a two-phase, convergent mixed
methods study. The 20-week quantitative phase utilised the EQ5D-3L, Hospital
Anxiety and Depression Scale, Life Attitude Profile-Revised and Rosenberg
Self-esteem Scale (n=21) to measure aspects of quality of life. The
exploratory qualitative phase employed individual Emotional Touchpoint
interviews (n=15) to investigate the lived experience of attending Specialist
Palliative Day Services (SPDS). Convergent findings revealed death anxiety
was triggered at point of referral and continued for some across the study
period. Convergent findings identified that self-esteem and mood were stable
and remained within normal parameters, while partially convergent findings
established that functional ability and symptoms were moderately affected by
illness and did not vary in severity. Partially divergent findings determined
meaning in life varied over time and was low in some across the study period.
SPDS supports normal self-esteem, mood and acceptable levels symptom burden.
However, SPDS does not appear to have an impact on meaning in life in all attendees.
Consequently, SPDS did not have a positive impact on overall quality of life
of all participants. To remedy this SPDS should be provided through a
rehabilitative framework which focuses on providing expert palliative care
within each domain of quality of life. Research should further explore the
components of meaning in life and how SPDS may support the existential well-being
of all attendees.

This poster is a visual representation of a 2-year
improvement project on recognising dying and delivering end of life care in
NHS mental health complex care wards in Renfrewshire. Driven by the desire of
staff to continuously improve this area of practice, in line with the
dementia strategy and standards and the Strategic Framework for Action.

In the wards a baseline survey was undertaken
with multidisciplinary teams to identify challenges encountered in palliative
and end of life care. Survey results informed the introduction of:

•
2 x Palliative Resource Nurses per ward who were trained and supported

• discovering a common language to improve
MDT and family and carers communication.

Ongoing work will include ward environment,
staff support and resilience.

03. A 'Vicious Cycle' of Heart Failure Care

Author(s)

Dr Karen Higginbotham; Em Prof Martin Johnson;
Prof Ian Jones

Aim:

The aim of this study was to explore the
decision-making process between healthcare professionals and patients in an
acute medical setting when it came to making end of life decisions.

Method:

A constructivist grounded theory was
conducted over a 12-month period in a District General Hospital in the North
West of England. A purposeful sample of 15 nurses, 11 doctors and 16 patients
were recruited from the acute medical setting. Data was collected using semi
structured interviews and focus groups. The interviews were recorded and transcribed
and data was analysed using the constant comparison and QSR NVivo.

Findings:

Four theoretical categories emerged from the
data to explain how healthcare professionals and patients negotiated the
process of decision making when considering end of life care. These four
categories; signposting symptoms, organising care, being informed and
recognising dying were found to revolve around a core category ‘vicious cycle
of care’ which was fast paced, turbulent and time limited. This cycle was
found to disable the process of decision making between the healthcare
professional and patient resulting in missed opportunity for the patient to
transition to palliative care.

Conclusion:

The emerging theory ‘vicious cycle of care’
offers an explanation as to why decisions were not made by healthcare
professionals to transition patients with end stage heart failure to palliative
care. Further work needs to be undertaken with healthcare professionals and
patients to map out a ‘cycle of care’ which identifies key stages in the
terminal stage of heart failure and correctly signposts the patient to the
right healthcare care professional for intervention. Further research is required with General
Practitioners to further explore the barriers to providing end of life care
for heart failure patients.

04. Bereavement in Prisons

Author(s)

Hannah Campbell-McLean

In November 2017, funding was provided from
Good Life, Good Death Good Grief to host an event in HMP Kilmarnock which
provided the population of HMP Kilmarnock with the opportunity to remember
loved ones who had died. The event was called 'absent friends'. This was
delivered by means of a coffee morning and was organised by NHS and various
Serco staff members including chaplaincy services, education and the Serco
senior management team. Outside speakers were invited in to talk about death
and dying including Scottish Families Affected by Alcohol and Drugs, Seasons for
Growth and the MacMillan Palliative Care co-ordinator for prisons.

Conversations were facilitated at small
tables and provided a safe environment for prisoners to have open and honest
conversations about people that they have loved and lost and allowed for
prisoners to reflect on the way that made them feel while in prison. This
event was very well received by the prison population and it was evident that
there is not enough support in HMP Kilmarnock for prisoners who have been
bereaved or indeed suffered loss. This then lead for further funding from the
NHS Endowment Fund for monies for training for staff in the Seasons for
Growth programme

05. Brief Engagement and Acceptance Coaching
for Community and Hospice Settings (the BEACHeS Study): Protocol for the
development and pilot testing of an evidence-based psychological intervention
to enhance wellbeing and aid transition into palliative care

Globally, cancer affects millions of
individuals, with a mortality rate of over 8 million per year. Although
palliative care is often provided outside of specialist services, many people
do, at some point in their illness journey, require support from specialist
palliative care services. This transition can be a time of uncertainty and
fear and there is a need for effective interventions to meet the
psychological and supportive care needs of patients with cancer at this time
in their illness. While Acceptance and Commitment Therapy (ACT) has been
shown to be effective across diverse health problems, robust evidence for its
effectiveness in palliative cancer populations is not extensive.

Method:

This study uses mixed-methods, in a single
case experimental design, to pilot test a novel intervention for this patient
group. Approx. 14 patients will be recruited from two hospices in England and
Scotland. Participants will receive five face-to-face manualised sessions
with a psychological therapist. Sessions are structured around teaching core
ACT skills of Openness, Awareness and Engagement, as a way to deal effectively
with challenges of transition.

Discussion:

The current study is the first investigating
ACT with terminally ill patients at the beginning of their transition from
curative to palliative treatment.

06. Building Blocks of End of Life Care

Author(s)

B Jackson, B Johnston, J McPeake

The aim of the review was to ascertain what
information and resources bereaved families and friends required before the
death of a relative or friend in an acute hospital setting. This rapid
systematic mixed method review was conducted from November 2017 to March
2018. The following six data bases were searched: CINAHL, MEDLINE, EMBASE, PUB
MED, PsychINFO AND WEB of Science. The initial search generated 432 articles,
then 26 full text papers were read of which 9 met the inclusion criteria. The
selected papers were then evaluated using Hawker et al (2002) and no papers
were excluded following the assessment. The themes were extracted using
techniques of conceptual analysis and ideas mapping Popay et al (2006).
Communication at end of life was found to be variable even within the same
clinical area. Relative and friends were expecting health care staff to be
available 24/ 7 and have the skills to deliver end-of-life care as it was in
an acute hospital. Staff attitudes and beliefs related to patients dying in
acute care requires further study.